Speculum Exam
Are you going to conduct a pelvic exam? Utilize our speculum exam template to help you with exam reminders and recording test results.
Fact Checked by Ericka Pingol.
What is a Speculum Exam?
A is one of the exams done during a pelvic exam. During this exam, the doctor in charge uses a speculum, a hinged and duck-billed-shaped device made of metal or plastic, to spread the vaginal wall to see the vagina and cervix better. Aside from aiding in a Pap smear, a test wherein the doctor uses a swab to collect cervix cells to check abnormalities that can lead to cancer, the speculum also helps observe for symptoms of sexually transmitted infections and other health issues.
A speculum’s exam results are written on a clinical note or are usually memorized by the doctor in charge. However, if you’re the doctor assessing your patient and need a document to record your patient results or a guide or reference for a speculum exam, check out our printable speculum exam template.
On our template, you will find the following:
- Basic information such as the patient’s name, your name, and examination date
- Reminders before you do a speculum exam
- Dedicated sections where you can record any observations and be reminded of the samples you took
- Space where you can write additional notes
Printable Speculum Exam
Download this Speculum Exam to accurately to conduct a pelvic exam.
How Does it Work?
Step One. Download the Template
Access and download a copy of our printable speculum exam template by doing either of the following:
- Clicking the “Use this Template” or “Download Template” button above
- Searching for the “Speculum Exam” in Carepatron’s template library on our website or app
Step Two. Go Over Reminders
Before you conduct the test, complete the required basic information, such as the patient’s name, your name, and the exam date. Then, go over the reminders written on the template and follow the instructions, such as explaining the speculum exam directions to the patient and asking for their consent.
To see if this will prove to be helpful to you or if you would like to make edits, we’ve added the reminders on the template below.
- Introduce yourself to the patient. Tell them your name and role.
- Ask for the patient’s name and date of birth for confirmation.
- Explain why you need a chaperone and how the exam will go in a language they’ll understand. Don’t forget to ask for their verbal consent.
- Ensure that they’ve passed urine and have told you if they’re experiencing pain or may be pregnant by asking them about either once more.
- Provide them with as much privacy by allowing them to undress in a separate room and cover themselves with a sheet while lying on the clinical examination couch.
- Before you begin, reassure them that you can stop immediately if it becomes too uncomfortable for them.
Step Three. Conduct the Test
Once your patient understands what the test entails, it’s time to gather the needed equipment, namely:
- Speculum
- Gloves
- Lubricant
- Sample Pot
- Endocervical Brush
For a refresher, here are the instructions for a speculum examination.
- Cover the exposed area.
- Inspect the vulva for any scars, abnormalities, etc.
- Wear gloves.
- Lubricate the speculum.
- With your non-dominant hand, part the labia, and with your dominant head, gently insert the speculum. The screw must be facing sideways, and the blades must be vertical.
- Rotate the speculum 90 degrees or until the screw faces upwards and the blades horizontal.
- Tighten the screw to keep the speculum open.
- You can swab or do a Pipelle biopsy to collect cell samples with your dominant hand.
Step Four. Record the Results
After you conduct the test and ask the patient to dress up, you can record any abnormalities you observed or, if none, tick your chosen process/es of collecting samples. Feel free to write down any additional notes in the space provided.
Speculum Exam Example (Sample)
Here’s our example of a filled-out speculum exam PDF template. Hopefully, this will provide insight into how this assessment may look when completed.
You can use an offline copy as a reference in the future by clicking the sample below or the “Download Example PDF” button above.
Download this Speculum Exam Example (Sample) here:
When Would You Use this Template?
Practitioners can use this template whenever they need to conduct a pelvic exam, specifically a pap smear or a speculum exam. To know if you must recommend conducting a speculum exam on your patient, you must check if they have symptoms or have a high risk of developing diseases or disorders.
To help you out, we’ve listed instances when you have to prepare a copy of a speculum exam template:
- Abnormal bleeding/vaginal discharge
- Pain in the pelvis or during sex
- Before or while getting an intrauterine device (IUD) or endometrial biopsy
- During the patient’s first prenatal care visit
- If the patient has a family history of ovarian/cervical cancer and gynecological conditions or if they are concerned that they’ve contracted an STD
Benefits
Early Recognition and Prevention
You can immediately conduct the test with a template when the patient consents. You won’t have to rush searching for reminders or what to look for in their cervix because all the needed information is on the template. As a result, you can conduct the test earlier, detect if there are any problems, and prevent the worsening of the patient’s condition.
Improves Monitoring
If the patient requires frequent pap smears and cervical exams, you can use the template as a document to compare with to check the progress of the medication or treatment. To add, if you’re teaching a less experienced doctor how to do the exam, you can use it as a guide to monitor if they are conducting the assessment correctly.
Written Copies of Results
Having a written copy of results reduces the risk of you forgetting your findings and can be more easily shared with other practitioners who may want to use it as a reference.
Fully Digital
Since our free speculum exam template is fully digital, it can be edited on any local PDF editor you have or on Carepatron. Even better, you can store it on Carepatron to keep an easily accessible copy for fellow practitioners caring for the same patient.
Why use Careaptron as your Speculum Exam App?
Beyond being a software where you can get the guide and template of the Speculum Exam, Carepatron is also a leading practice management software for streamlining business and clinical processes and automating tasks. Utilize Carepatron’s features, aside from editing the Speculum Exam template right on the software, to accomplish your responsibilities outside patient care.
Download our application on your desktop or iOs/Android gadgets to have access to the following for free:
- More than 300 editable and printable templates of medical documents like tests, assessments, and surveys downloadable in PDF form.
- A template creator and uploader in case you can’t find one from our library.
- A HIPAA-compliant secure EHR system for all your digital notes and clients’ medical records.
- Integration with calendars for ease of scheduling and video call solutions for teleconsultation
- An automated payment system you can set up for your client
All these and more are available right at your fingertips if you sign up on Carepatron today!
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References
Pelvic Exams. (2023). Retrieved 2 June 2023, from https://www.acog.org/womens-health/faqs/pelvic-exams#:~:text=The%20American%20College%20of%20Obstetricians,should%20make%20this%20decision%20together.
Commonly asked questions
Health care professionals such as obstetrician-gynecologists are the ones who may benefit from our speculum exam template the most.
You use the speculum exam template for a pelvic exam or pap smear. For specific instances when you must conduct this assessment, refer to the “When Would You Use this Template?” section above.
It assesses a patient’s vagina and cervix to check if there are any abnormalities that can lead to complications or conditions.
